Provider Demographics
NPI:1679584965
Name:SOWERBY, PRIYA CLARKE
Entity type:Individual
Prefix:MS
First Name:PRIYA
Middle Name:CLARKE
Last Name:SOWERBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:KATHLEEN
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:25 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2906
Mailing Address - Country:US
Mailing Address - Phone:707-526-8300
Mailing Address - Fax:707-776-0935
Practice Address - Street 1:25 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2906
Practice Address - Country:US
Practice Address - Phone:707-526-8300
Practice Address - Fax:707-776-0935
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38354106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist